Transferencia de dorsal ancho versus pectoral mayor para la deficiencia masiva del manguito rotador: Una revisión integrativa de resultados funcionales y complicaciones
DOI:
https://doi.org/10.66201/ss.v1.12Palabras clave:
rotura del manguito de los rotadores, transferencia tendinosa, músculo dorsal ancho, músculos pectorales, rango de movimiento articular, resultado del tratamiento, fenómenos biomecánicosResumen
Introducción: Los desgarros masivos e irreparables del manguito rotador plantean un desafío reconstructivo crítico en pacientes jóvenes y activos. Ante el vacío terapéutico entre la reparación fallida y la artroplastia, las transferencias tendinosas del dorsal ancho (LD) y del pectoral mayor (PM) emergen como opciones biológicas de salvamento. El objetivo de esta revisión fue sintetizar la evidencia sobre la eficacia clínica, biomecánica y seguridad de ambas.
Métodos: Se buscó literatura en PubMed, Scopus y Web of Science (2008–2025), seleccionando estudios con N > 10 que reportaran resultados funcionales (Constant, ASES), rango de movimiento y complicaciones. Se excluyeron artroplastias primarias y estudios cadavéricos.
Resultados: Ambas transferencias mostraron perfiles biomecánicos distintos. El LD fue superior en la restauración de la elevación anterior (hasta 160°) y rotación externa para defectos posterosuperiores, aunque con mayores tasas de ruptura del injerto (30–43 %) y complicaciones neurológicas (3–10 %). El PM resultó más eficaz para la estabilidad anterior e insuficiencia del subescapular, con menor tasa de infección (1–3 %) y de conversión a artroplastia (4 % vs. 12.3 %). La integridad del teres minor fue el predictor pronóstico más robusto para el éxito del LD.
Conclusiones: El LD y el PM no son intercambiables; son herramientas complementarias definidas por la anatomía del defecto. El LD restaura el vector posterior y la elevación, mientras que el PM rescata la competencia anterior. La elección quirúrgica debe basarse en la localización del desgarro, la integridad del teres minor y la tolerancia al riesgo del paciente.
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Derechos de autor 2026 Enzo Eugenio Olmedo Gómez, Pedro Fabian Martínez Vera (Autor/a)
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
